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Updated: May 28, 2026

Imaging Features of Systemic Sclerosis-Associated Interstitial Lung Disease
Published on: June 16, 2020
Anti-Ro/SSA and rheumatoid factor antibodies are associated with more severe lung involvement in patients with
Blaž Burja1, Marouane Boubaya2, Cosimo Bruni1
1Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Background:
As precision medicine is needed in systemic sclerosis (SSc) and SSc-associated interstitial lung disease (ILD), SSc non-specific antibodies might improve the risk stratification in this population.
Research Question:
To evaluate the prevalence and characterize the disease phenotype of SSc patients positive for anti-Ro/SSA alone or in combination with RF antibodies in the largest cohort of SSc patients, focusing on lung involvement.
Methods:
Patients from the EUSTAR database with available data on anti-Ro/SSA and RF antibodies were included. Clinical characteristics of patients with or without anti-Ro/SSA and RF antibodies were compared at baseline. Multivariable logistic regression models were built to identify factors associated with ILD. In patients with ILD at baseline, multivariable mixed-effects models for longitudinal FVC and DLCO were built to assess the impact of anti-Ro/SSA and RF. Prognostic factors for the ILD progression and death during follow-up were tested by multivariable Cox proportional hazards regression.
Results:
Among the 4,221 patients fulfilling the inclusion criteria, 641 (15.2%) had anti-Ro/SSA antibodies. These patients exhibited a higher prevalence of muscular involvement (p < 0.01), pulmonary hypertension (p = 0.06), and ILD (p < 0.01) at baseline. Over 14,066 follow-up visits, anti-Ro/SSA independently predicted the presence of ILD (OR 1.24 [1.07-1.43], p < 0.01). Among anti-Ro/SSA+/RF+ patients, who represented 4.1% of the cohort, ILD was more prevalent as compared to single positive or negative anti-Ro/SSA and RF patients. Anti-Ro/SSA+/RF+ double-positive patients had a more severe ILD, with lower FVC% (R -4.12 [-7.85;-0.40]; p = 0.03) and lower DLCO% (R -5.4[-9.05;-1.74]; p < 0.01).
Interpretation:
In the large EUSTAR cohort, anti-Ro/SSA antibodies are detected in 15% of SSc patients and represent an independent risk factor for the presence and severity of ILD, particularly for cases with anti-Ro/SSA+/RF+ double positivity. These data support the inclusion of anti-Ro/SSA and RF antibodies in routine clinical practice to improve the risk stratification of SSc patients.
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